Doctor's Letter

After a difficult hospital appointment, I wrote this (unsent) letter to my liver specialist

Dear Dr A

I was pleased to see you again ten days ago. I have previously seen you three or four times at the Liver Clinic – your specialism – so I was pleasantly surprised to see a familiar face at the Diabetes and Endocrinology Clinic. You came into the waiting area to call another patient in, and said hello.  

While waiting I had a body composition scan with a nurse: ideal weight 57.5 kgs.

This was my weight on my tenth birthday: my mother kept meticulous records on my weight, if not on much else.

The clinic ran about an hour late. You came into the waiting area and called my name. Although you remembered me clearly, you asked, “Is the walking stick a new thing?”

“No, I’ve always had it – well, not always, but for the last six years, and certainly since I’ve met you.”

 In a previous appointment I had explained that ankle arthritis limits my ability to walk for long, and you’d said, “Hmm, yes, this is a problem.”

We entered the consultation room. Another doctor, the endocrinologist Dr B, sat at a desk facing a computer screen. You introduced him. We exchanged minimal small talk.

You took the seat on his other side and began typing up – my notes perhaps?

I sat facing you two, or rather facing your sides. Dr B began talking to the screen.

“Blood sugar is not controlled adequately, so we need to look for alternatives,” he said.

He mentioned the weekly injectable Ozempic – but: “At present there is a Europe-wide shortage because many people use it for weight loss. The shortage will probably last until the end of the year, so it’s not much use at present. However, there is an alternative, the daily injectable Victosa: a nurse will show you how to do it and then you will have to inject yourself.”

I remained silent.

I am five years old and have developed pneumonia from sleeping with the fan on. The local nurse comes every evening to give me an injection. I can hear the syringes jingling in her metallic box as she walks out of the lift in our flat in Athens, Greece. I hide myself under my parents’ bed, confident that they will never find me, and that she will go away. The chat show Salt & Pepper is on TV, but I don’t dare peek, lest they see the bedcover twitch. I hate needles. I have hated needles ever since.

Your Apple watch buzzed and you answered it in another language.

Dr B continued. “Victosa can also reduce feelings of hunger, which may also help.”

I said that physical hunger is not really an issue; there are other factors like compulsive eating, stress and frustration in family relationships that raise my blood sugar levels.

“Well, if there are other factors, you need to address them separately,” he said.

Where? With whom? Not in your job description.

 “Can I think about all this a bit more?”

 “Of course. I will put in a referral to the Weight Management team, but it won’t happen immediately anyway,” Dr B says. “You will be given full information before you make any decisions.”

Your telephone conversation over, you returned to the consultation at hand. You’d missed the bit about the compulsive eating, stress and frustration. To be fair, I did not say it in so many words, making it easy to ignore.

Little Sophie drops a subtle hint at how she experiences things; she expects that someone – anyone – will pick it up and come to rescue her; she is frustrated that no-one saw she wasn’t waving but drowning.

In my adult life, frustration now translates into a heat release from the liver into the bloodstream; a buzzing at the temples; a hard ball knocking against my ribs. The glucose that is meant to fuel the fight or flight response floods my bloodstream and has nowhere to go.

Dr B moved on to daily exercise, possibly swimming too if arthritic pain is an issue. He pointedly said, “But even if exercise or walking may not be possible or effective, control of calorie intake most certainly is.”

It’s up to you and your willpower, Mama admonishes. She was overweight herself.

You jumped in to add that I am on the list for a cirrhosis drug undergoing clinical trials at present, but that there is no way of knowing whether I will be in the drug or the placebo group. In any case, this is quite far into the future.

Dr B started on the bariatric surgery options. I must have appeared hesitant again; you interjected that pre-op investigations would determine whether I am eligible for bariatric surgery anyway, because a cirrhotic liver hangs in front of the stomach, making the operation more difficult.

You continued. “You are relatively young – the liver may gradually move towards decompensation, possibly in two or three years. Think of what liver transplant will be like if you are skeptical about bariatric surgery.”

November 2010, Tehran. After being laid up in bed for weeks with sciatica pain, I saw a famous neurosurgeon. I was in so much pain that I had the backrest of the car seat lowered and rode in the car lying sideways for the duration of the journey. I had to lie down on a gurney while waiting. The room was packed with people exchanging experiences and advice. The doctor examined me: bend over to touch your toes; stand on your toes; walk a few steps on your toes (couldn’t do any of them). Then he uttered the definite pronouncement: “Unless you have a vertebral fusion operation in the next two weeks, you will end up on a wheelchair.”  I did neither.

I was overwhelmed, bombarded with all this information machine-gun style. No wonder I just sat there looking at Dr B looking at the computer screen. He seemed to be mentally ticking boxes.

“You don’t seem keen on anything we suggest,” you added. “I don’t think you realise how serious your condition is.”

“On the contrary,” I replied, “I realise very well how serious this is. I have read a lot about it.”

“But I see you quite relaxed.”

The story of my life: the calm exterior always, still, hiding the grief, the anger, the pain.

“We are trying our best to keep you alive,” you continued, “but…”

I am not afraid of death – although I am afraid of what may come before it.

Dear Dr A, I know the clinic was running late. I like to think that this is why you seemed to be losing patience, and not, God forbid, that you lacked empathy and sensitivity – or worse, that you were sliding into medical arrogance.

All the same, I felt that you were looking at a set of figures and medical reports rather than at a real person who is more than the sum of her parts, her blood sugar readings and her weight in kgs. I was unable to process all this information at such speed, but my difficulty seemed to be below your radar. I felt not seen.

In all the long years of your medical training and specialization weren’t you ever taught the importance of creating rapport with a patient? It’s not that hard: it could be something as small as a softer voice tone, a sympathetic facial expression, even a pause. None of these take more time than their alternatives; and they may make your job and the patient’s life a little bit easier.

The rest of the strands…

Stoic practice and The Stoic Salon

While the supportive community at the Stoic Salon are taking a well-deserved summer break, I started my own daily practice reading Marcus Aurelius’ Meditations. I have read extracts here and there before, but have never read the whole work cover to cover. It becomes ever clearer why the Greek title is [Notes] To Self, (Εις εαυτόν): one of the most powerful men of his time enters into dialogue with himself, as he grapples with how to face life’s problems; how to deal with people; the transience of life; and letting go.

Some sections consist of several paragraphs, others are as short as a single sentence, as he meets himself on the page at the end of every exhausting day. I can see him thinking, engaged in the process of writing to/for himself, completely detached from the outcome of how the text would read to other readers.

Here’s the lesson for me as I write and sing: Focus on the process as it unfolds in the present moment; the outcome will take care of itself.

Memoir and Life Writing

The Memoir and Life Writing group at The London Writers Salon, continues to meet up on the 1st and 3rd Thursday of each month, to get to know each other, talk about our work and share experiences and resources. A small subgroup has now formed to provide support and to workshop each other’s work as we prepare to enter the Bridport Prize Memoir Award (deadline 30 September 2023).

The next community meeting of the Memoir and Life Writing group is on Thursday 20 July, 5-6 pm BST, when we will catch up and check-in with successes and gripes.

If you would like join hundreds of other writers writing in community, join the Writers’ Hour; one of the four daily sessions and one Saturday session is bound to fit in with your daily schedule. We can’t wait to welcome you and to write together!

The heart meets the (left) hand in an embrace of imperfection